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(Chest. 2005;128:3750-3756.)
© 2005 American College of Chest Physicians

Oral Forms of Tetracycline and Doxycycline Are Effective in Producing Pleurodesis*

Semra Bilaceroglu, MD, FCCP; Yubiao Guo, MD; Michael L. Hawthorne, MD; Zhiwen Zhu, MD; Georgios T. Stathopoulos, MD; Kirk B. Lane, PhD and Richard W. Light, MD, FCCP

* From the Department of Pulmonary Medicine (Dr. Bilaceroglu), Izmir Training and Research Hospital for Thoracic Medicine and Surgery, Izmir, Turkey; Department of Pulmonary Medicine (Drs. Hawthorne and Light), Vanderbilt University and St. Thomas Hospital, Nashville, TN; Department of Respiratory and Critical Care Medicine (Drs. Guo and Zhu), First Affiliated Hospital of Sun Yatsen University, Guangzhou, PR China; and Department of Pulmonary Medicine (Drs. Stathopoulos and Lane), Vanderbilt University, Nashville, TN.

Correspondence to: Semra Bilaceroglu, MD, FCCP, Associate Professor of Pulmonology, 6026 Sokak, No. 197/22, 35560 Bostanli, Izmir, Turkey; e-mail: semrab{at}superonline.com

Purpose: We investigated whether oral tetracyclines could produce an efficient and safe pleurodesis as does parenteral doxycycline, which is currently unavailable in many countries.

Methods: Parenteral doxycycline (10 mg/kg), oral tetracycline (35 mg/kg), or doxycycline (10 mg/kg) was injected intrapleurally through a right chest tube in rabbits. The oral forms were dissolved in saline solution and passed through a sterile membrane filter. When daily aspirated pleural fluid was < 5 mL/24 h, the chest tube was removed. Fluid WBC, lactate dehydrogenase (LDH), and protein levels were measured 24 h after the injection. After the death of the animals on day 14, pleurodesis was graded from 1 (none) to 8 (> 50% symphysis) by two observers blinded to treatment groups.

Results: The right pleurodesis score of the combined oral groups (median, 7.0; interquartile range [IQR], 4.0; n = 26) did not differ significantly (p = 0.349) from that of the parenteral group (median, 7.5; IQR, 6.0; n = 10). Oral tetracycline (capsule or tablet, n = 6 in each group) and doxycycline (capsule or tablet, n = 7 in each group) were as effective as parenteral doxycycline in producing pleurodesis: tetracycline capsule (median, 7.50; IQR, 6.00); tetracycline tablet (median, 6.50; IQR, 6.00); doxycycline capsule (median, 4.00; IQR, 1.00); doxycycline tablet (median, 8.00; IQR, 5.00), and parenteral doxycycline (median, 7.50; IQR, 6.00) [p = 0.235]. The left pleurodesis scores were 1.00 in all 36 rabbits. Fluid total volume, WBC, LDH, and protein levels were comparable between each oral and parenteral group, excluding WBCs in the tetracycline tablet group (p = 0.047). The complications were nonfatal (right hemothorax: tetracycline capsule [n = 3]/tetracycline tablet [n = 2], doxycycline tablet [n = 2], parenteral doxycycline [n = 2]; left hemothorax: tetracycline capsule [n = 1]; ascites: parenteral doxycycline [n = 1]). There was no growth on all filtrate cultures. Oral forms cost less than parenteral doxycycline (<$1 vs $4.72 per rabbit). Filtering costs were $1.12 per rabbit.

Conclusion: Oral tetracycline or doxycycline is as effective and safe as parenteral doxycycline in producing pleurodesis in rabbits; thus, they may also be used in humans.

Key Words: capsule • doxycycline • pleurodesis • tablet • tetracycline






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